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Oncoshare-Lung:

A shared database for lung cancer by integrating multiple electronic health record systems from community-based and academic healthcare systems through a novel 3-way linkage.

Overview: The Oncoshare-Lung Initiative

Stanford and Sutter Health together cover a broad geographical region across Northern California

Northern California counties served by Sutter Health

The mission of the Oncoshare-Lung initiative is to build a comprehensive database for lung cancer research that integrates data across multiple healthcare systems and national resources: electronic health records (EHR) from all Stanford Health Care and over 23 Sutter Health Hospital sites across Northern California, linked to the statewide California Cancer Registry.

The integration of two large healthcare systems across academic and community-based centers with a population-based registry data source enables the combination of curated, standardized data with nuanced clinical detail for each patient, presenting a unique opportunity to investigate and improve care delivery and outcomes for patients with lung cancer.

This project was initiated in 2023 as part of the Oncoshare initiatives originally founded in 2008, with the goal of using a “big data” approach to improve cancer care and delivery. The current domains of Oncoshare include breast and lung cancers.

Using the well-curated database, we aim to develop clinical decision tools for efficiently managing lung cancer patients by developing novel computational frameworks and evaluate real-world effectiveness of surveillance and treatment strategies using various causal inference and/or machine learning methods for lung cancer patients.

What is 3-way linkage?

The EHR contains rich and granular details about a patient’s medical and treatment history – but only as far as the patient visits the same health system for their care. Thus, single institution clinical research is often limited by fragmented patient history. Records at community practices may not reflect treatments completed at tertiary, referral academic practices, while those at academic practices may lack the comprehensive view of community practices. Further, EHR does not track the list of lung cancer diagnoses nor guarantee long-term follow-up.

Registry data provide accurately ascertained lung cancer cases, tumor characteristics, first-line treatments and long-term follow-up outcome. However, registry data lack the refined details such as cancer surveillance, presence of biomarkers or driver mutations, subsequent lines of therapy, and progression-free survival. With increasing use of novel therapies such as immunotherapy and targeted therapy, such information is crucial for performing real-world evidence studies.

The linkage consists of linking EHR from Stanford Healthcare, Sutter Health, and the California Cancer Registry. Stanford Healthcare – an academic practice – and Sutter Health – a neighboring community practice in the same catchment area complements data from each other. Stanford provides data in a referral setting while Sutter Health provides a more consistent, continuous record of care. Linkage to the California Cancer Registry allows accurate ascertainment of cancer cases and curated baseline and long-term follow-up data, while EHR provides nuanced in-between treatment records. This approach covering a broad geographical region in Northern California also enhances the generalizability of study findings by capturing a more diverse range of race, ethnicity, and socioeconomic status.

Investigators

Summer Han, PhD, Principal Investigator

Dr. Han is the lead PI of Oncoshare-Lung at Stanford University. Dr. Han is an Associate Professor of Neurosurgery, Medicine, and Epidemiology & Population Health in the Stanford School of Medicine. She holds a PhD in Statistics (Yale, 2009) with a concentration on statistical genetics. Dr. Han's research focuses on developing novel statistical methods for understanding the interplays between genes and the environment and for evaluating efficient screening strategies based on etiological understanding. She is the Principal Investigator of the NIH funded project for conducting GWAS, building risk prediction models, and developing decision analysis for cancer screening for second primary lung cancer (SPLC).

Su-Ying Liang, PhD, Sutter Health Principal Investigator

Dr. Liang leads the Oncoshare-Lung efforts at Sutter Health. Dr Liang is a Research Economist at the Palo Alto Medical Foundation Research Institute (PAMFRI). She also holds appointments as a research health economist (since 2000) and adjunct professor at the University of California, San Francisco (since 2011). Previously, she was an assistant professor at Arizona State University.

Heather Wakelee, MD, Thoracic Oncologist

Dr. Wakelee specializes in the treatment of lung cancer, thymoma and mesothelioma. She completed all post-graduate training at Stanford University and joined the faculty in 2003. For many years she was the physician lead for the thoracic malignancies clinical research group and has developed research programs related to lung cancer and thymoma across multiple areas including clinical trials, translation work and population sciences. She is the Principal Investigator on numerous clinical trials. In 2021 Dr. Wakelee took on the role of Deputy Director of the Stanford Cancer Institute and is the Division Chief of Medical Oncology. She is also active in many national and international organizations related to lung cancer and thymoma including leadership roles in the International Association for the Study of Lung Cancer (IASLC).

Allison Kurian, MD, MSc, Oncologist

Dr. Kurian is the PI of Oncoshare-Breast and currently also serves as PI for Oncoshare-Lung. Dr. Kurian is a Professor of Medicine and of Epidemiology and Population Health at Stanford University School of Medicine. She received her medical degree from Harvard Medical School, trained as an intern and resident in Internal Medicine at the Massachusetts General Hospital, and completed her fellowship training in Medical Oncology along with a master’s degree in Epidemiology at Stanford University. Dr. Kurian’s research focuses on cancer genetics, precision oncology and the quality of cancer care at the population level.

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Oncoshare-Lung Initiative